Previously known as impotence, erectile dysfunction as define by The National Institutes of Health is the consistent inability to achieve and/or maintain an erection satisfactory for the completion of sexual performance. Heard fondly joke and called ED as 'the pencil with no lead', 'the drop' or 'having the software but no hardware".

Is ED inevitable in the aging male?

By the time a man is 40 years old, 90 percent of them have experienced at least one erectile failure. This is a normal occurrence, but many men get "panic" at the first sign of erectile problems. They are likely to run to an urologist and ask for the highly publicized impotence pill, which they may not need and may or may not find effective. His lack of knowledge about the sexual aging process to set him up for performance problems and that might have led his wife to blame herself for his lack of interest in making love and caused her to withdraw from attempts to initiate sex. If he hadn't received good advice and reassurance from someone he trusted, one might have "worried himself into impotence."

When it is Not Impotence?

Most men, however, know that the occasional erectile problem is typically linked to fatigue, over consumption of food or drink, or a relationship issue. At midlife, a man may read a lot about impotence. He may see his future in a failed erection. How he and his partner handle these occurrences helps determine how frequent they will be. These common changes in sexual response at midlife aren't indicators of impotence:

A man probably needs direct penile stimulation to have an erection, and he may no longer be able to get an erection just from thinking about sex or seeing his partner in an alluring pose. It may take him longer to achieve erection.

He may require more time for ejaculation and may not need to ejaculate every time he has intercourse. After a period of intercourse, he may find his erection subsides. After ejaculation, he also may find his erection subsides more quickly than it did. His erection probably won't be as hard as it was when he was a teenager.

The recovery time of older a male between ejaculations are usually longer. These changes are gradual, and you shouldn't be frightened by them. Changing response patterns enable a man to be a better lover than he was because he is now responding at a pace more similar to his partner's. Lack of knowledge and refusal to accept the aging process as an erotic opportunity can prevent him from seizing the sexual moment. Anxiety also plays a major role in creating impotence dynamic. If a man misinterprets his responses and becomes anxious about his potency, he will be tense and fearful about lovemaking and convey those negative attitudes to his partner.

Some men do experience erection difficulties that are much more serious than the normal. Psychological factors ranging from performance and stress issues to intimacy conflicts can contribute to erection disorders. Physical problems can also cause impotence. Illnesses such as diabetes, vascular disease, urological or neurological conditions, and others, can lead to impotence. Heavy smokers and alcohol drinkers may suffer extensive damage to the small blood vessels in the penis, again leading to impotence. For some men, impotence stems from a combination of physical and psychological factors. They need to be treated from a multi disciplinary healthcare perspective, with a therapist and medical doctors involved. Injections or medication pill alone won't solve their problem.

When ED is psychological

"I was terrified at the thought of having a penile implant," says Sam. "but I'd been suffering bouts of impotence for almost a year and I thought it was probably time to do something about it, even if that turned out to be surgery." Sam and his partner, Mary, 50s, were very discouraged about his erection problems by the time he sought help from his doctor. Though he sometimes had morning erections and sometimes was able to get an erection for masturbation, he was increasingly not able to become erect during lovemaking. Once he did get an erection, he would lose it quickly. And Mary was convinced she could 'make' him get up and keep a good erection. Both of them became worried and "obsessed" with the condition of his penis. They spent so much time watching his penis whenever they try to attempt to make love, so much so they'd turned sex into a spectator sport.

Sam's "sometimes" experienced and his ability to get an erection "sometimes" during masturbation were indicators that his problem might not be entirely physical or, if it was largely physical, his condition probably wasn't as far advanced as he feared. Routine medical tests showed that he had very high cholesterol levels, no surprise given his diet rich in saturated fats and diary cholesterol. The same substances that clog the arteries of the heart, his doctor explained; also clog the arteries of his penis. The damage done by a poor diet and high cholesterol levels had caused some problems with impotence for Sam. His doctor prescribed a diet and medication to bring down the cholesterol and recommended several sex-therapy sessions both alone and with his partner.

The above is rather common in elder health group. Both Sam and Mary are suffering from performance anxiety. Sam's case of "sometime can" and "sometime can't" may be referred as primarily impotent. The primarily impotent man arbitrarily has been defined as a male never able to achieve and/or maintain an erection quality sufficient to accomplish successful intravaginal connection. If erection is established and then lost under the influence of real or imagined distractions relating to intercourse opportunity, the erection usually is dissipated without accompanying ejaculatory response. No man is considered primarily impotent if he has been successful in any attempt at intromission in either heterosexual or homosexual opportunity. As Sam's case illustrates, impotence has a psychological component even when the cause is physical.

Psychological impotent is usually found in the young adolescent male. It is erectile dysfunction in the mind. The young male usually try to make his 'first attempt' at his or her home, worried about his physics and performance, sometime religion background. Tried mounting into the vagina excitedly and clumsily. The fear of being caught by his parents and sometime rejection by his partner may cause him to lose his erection. The penis is weakening even before putting on the condom, thus, unable to penetrate the vagina successfully. This problem may happen again and again with the same or different partner. Technically, his unsuccessful attempts remain him as a virgin. This leave the poor young man feeling humiliated as resulted.

Fortunately, most young men whom failed to perform successfully during their initial coital exposure and for a considerable period of time remained sexually inadequate. But yet they have recovered from their experiences with sexual dysfunction without specific psychotherapeutic support and, as far as can be ascertained from corroborative histories of husband and wife, have led effectively functional heterosexual lives. Others manage to regain as time passes. They at least partially neutralize the negative influences that have accrued as a combination of their environmental backgrounds and the trauma of their initial failures.

If Sam and the young man, could learned how to make love without so much emphasis on an erection and intercourse. It's really better and more sophisticated. However, if this psychological impotent is not treated soon, it may become physically permanent.

Psychological factors:

Depression

Sexual phobia

Religious beliefs

Performance anxiety

Attitude towards sex

Failure in relationship

Traumatic sexual experience

Physically ED

Mr. Z has a habit of cocktails before dinner frequently wine with his meals, and possibly a brandy afterward. At business point of view he has moved progressively up the ladder to the point at which alcohol intake at lunch is an integral part of the business culture. In short, consumption of alcohol has become a way of life.

On a Saturday evening, the man and his wife attended a party where alcohol is available in large quantity. Somewhere in the course of the late evening or the early morning hours, the party comes to an end. Mr. Z has had entirely too much to drink, so his wife drives them home for safety's sake. His wife retires to the bedroom quickly, and with a sense of vague irritation, a combination of a sense of personal rejection and a residual of her social embarrassment, prepares for bed.

However, Mr. Z has some trouble with the stairs, manages to arrive at the bedroom door. Suddenly he decides that his wife is indeed fortunate tonight, for he is prepared to see that she is sexually satisfied. It never occurs to him that all she wants to do is go to bed, hoping to sleep and avoid a quarrel at all costs. He approaches the bed, moves to meet his imagined commitment and nothing happens. He has simply had too much to drink. Dismayed and confused both by the fact that no erection develops and that his wife obviously has little or no interest in his gratuitous sexual contribution, he pauses to resolve this complex problem and immediately falls into deep slumber.

The next day, he is further traumatized by the symptoms of an acute hangover. He surfaces later in the day with the concept that things are not as they should be. The climate seems rather cool around the house. He can remember little of the last evening's festivities except his deeply imbedded conviction that things did not go well in the bedroom. He is not sure that all was bad but heal so is quite convinced that all was not good.

Obviously he cannot discuss his predicament with his wife. She probably would not speak to him at this time. So he kept mute throughout the evening and goes to bed early to escape. He sleeps restlessly only to face the new day with a vague sense of alarm, a passing sense of frustration, and a sure sense that all is not well in the household the Monday morning. He thinks about this over a drink or two at lunch and another one during the afternoon. On the way home from work, decides to check out this evening the little matter of sexual dysfunction, which he may or may not have imagined.

If the history of this reaction sequence is taken accurately, it will be established that Mr. Z does not check out the problem of sexual dysfunction within 2 days of onset, as he had decided to do on his way home from work. He arrives home, finds the atmosphere still markedly frigid, makes more than his usual show of affection to the children, retires to the security of the cocktail hour and goes to bed totally lacking in any communicative approach to his frustrated irritated marital partner.

On Tuesday morning, while brushing his teeth, Mr. Z has a flash of concern about what may have gone wrong with his sexual functioning on Saturday night. He decides unequivocally to check the situation out tonight. Instead of thinking of the problem occasionally as he did on Monday, his concern for "checking this out" becomes of paramount importance. On the way to work and during the day, he does not think about what really did go wrong sexually because he does not know either. Needless to say, there is resurgence f concern for sexual performance during the afternoon hours, regardless of how busy his schedule is

Mr. Z leaves the office in relatively good spirits, but thoroughly aware that "tonight's the night." He does have vague levels of concern which suggest that a little relaxation is in order; so he stops at his favorite tavern for a couple of drinks and arrives home with a rose only to find not only a forgiving, but an anticipatory, wife, ready for the reestablishment of both verbal and sexual communication that a drink or two together before dinner can bring.

Probably, for the first time in his life, he approaches his bedroom in a self conscious 'Till I show her attitude. Again there has been a little too much to drink--not as much as on the party night, but still a little too much. And, of course, he does show her. With his conscious concern for effective sexual function and the onset of his fears of performance, that, aided by the depressant effect of alcoholic intake, he simply cannot "get the job done." When there is little or no immediate erective reaction, he tries desperately to force the situation in turn, anticipating an erection, then wildly conscious of its absent, and finally demanding that it occur, of course, he got no erection.

While in an immediate state of panic, as lie sweats and strains for his weapon to function, he simultaneously must contend with the added distraction of a frightened wife trying to console him in his failure and to assure him that the next night will be better for both of them. Both approaches are equally traumatic. He hates both her sympathy and blind support which only serve to underscore his "failure," and reads into his wife's assurances that probably he can do better "tomorrow" a suggestion that no longer can he be counted on to get the job done sexually when it matters "today." A horrible thought occurs to him. He may be developing some form of sexual incompetence. He has been faced with two examples of sexual dysfunction. He is not sure what happened the first time, but he is only too aware this night that nothing has happened. He has failed, miserably and completely, to conduct himself as a man. He cannot attain or maintain an erection.

Further, Mr. Z knows that his wife is equally distressed because she is frantically striving to gloss over this marital catastrophe. She has immediately cast herself in the role of the soothing, considerate partner who says, "Don't worry dear, it could happen to anyone," or "You've never done this before, so don't worry about it, dear." In the small hours of the morning, physically exhausted and emotionally spent from contending with the emotional bath her husband's sexual failure has occasioned, she changes her tune to "You've certainly been working too hard, you need a vacation," or "How long has it been since you have had a physical checkup?" Similarly heard wifely remarks which supposed to soothe, maintain, or support are interpreted by the panicked man as tacit admission of the tragedy they must face together: the progressive loss of his sexual functioning.

From the moment of second erective failure (72 hours after the first such episode), this man may be impotent. In no sense does this mean that in the future he will never achieve an erection quality sufficient for intromission. In brief, fears of sexual performance have assumed full control of his psychosocial system. Mr. Z thinks about the situation constantly. He occasionally asks friends of similar age group how things are going, because, of course, any male so beleaguered with fears of sexual failure is infinitely desirous of blaming his lack of effective function on anything other than himself, and the aging process is a constantly available cultural scapegoat.

He finds himself in the position of the woman with a lifetime history of non orgasmic return that contends openly with concerns for the effectiveness of her own sexual performance and secretly faces the fear that in truth she is not a woman. In proper sequence, he does as she has done so many times. He develops ways and means to avoid sexual encounter. He sits fascinated by an x-rate movie, in order to avoid going to bed at the usual time with a wife who might possibly be interested in sexual contact. He fends off her sexual approaches, real or not, with excuses; "I don't feel well," or "it's been a terrible day at the office," or "I'm so tired." He jumps at anything that avoids confrontation.

His wife immediately notices his disinclination to meet the frequency of their routine sexual intercourse. In due course she begins to wonder whether he has lost interest in her, or if there is someone else, or whether there is truth in his most recent assertion that he couldn't care less about sex. For reassurance that she is still physically attractive, the concerned wife begins to push for more frequent sexual encounters, the one approach that the self pressured male dreads above all else. Obviously, neither marital partner ever communicates his or her fears of performance or the depth of their concerns for the sexual dysfunction that has become of paramount importance in their lives. The subject either is not discussed, or, if mentioned even obliquely, is hastily buried in an avalanche of words or chilled by painfully obvious avoidance.

Within the next two or three months, Mr. Z failure to erect for a time or two begin to make both husband and wife panic. She decides independently to avoid any continuity of sexual functioning, eliminate any expression of her sexual needs, and be available only should he express demand. And because she also has also developed fears of performance, her fears are not for herself but for the effectiveness of her husband's sexual functioning. She goes to great lengths to avoid anything that might be considered sexually stimulating, such as too-long kisses, handholding, body contact, caressing in any way. In so doing she makes such sexual encounter much more of a pressured performance and therefore, in much less of a continuation of living sexually, but the thought never occurs to her.

Over the centuries, the male sexual dysfunction has been the level of 'cultural' demand for effectiveness of male sexual performance. Most men feel that they must accept full responsibility for establishing successful intercourse connection, has placed upon every man the psychological burden for the lovemaking process and has released every woman from any suggestion of similar responsibility for its success. Well, there has never been an impotent woman anyway.

When a male loss the ability to achieve and to maintain an erection, it can cast a shadow of doubt upon the effectiveness of his sexual performance and this disturbed the state of his masculinity. Once a shadow of doubt has been cast, it will be registered at his mind for awhile or even longer. He may become more anxious about his next potential sexual encounter. Failure to attempt coital or intercourse connection continuously might lead to a subsequent pattern of erection failure to be established. Some men whom experience more serious than normal erection difficulties (example absence of nocturnal or nighttime erection, morning erections, no erection when stimulated,) associated with aging and chronic illness for instance:

Heart disease.

Any disease process that can affect arteries may likely affect the arteries that supply the penis. Men contracted with coronary artery disease or pain in the chest, cerebro vascular disease, peripheral vascular disease, high blood pressure and high cholesterol. Accidents that cause severe pelvic fracture or direct injury to the penis are at risk for erectile dysfunction.

Diabetes.

A major physical cause of impotence, diabetes can also accelerate other causes like penile artery damage from cholesterol may become significant in a shorter period of time than it would if not complicated by diabetes.

High cholesterol.

Impotence research in the past several years has led a few authorities such as the New England Male Reproductive Center at Boston University Medical Center to conclude that high cholesterol is "probably one of the leading causes of impotence in America. The penis is a vascular organ, made up of layers of venous tissue and blood vessels. High cholesterol adversely affects erectile tissues.

Prostate problems.

Chronic pain and swelling in the prostate area can affect sexual functioning in an indirect manner if a man finds erection or ejaculation painful or uncomfortable. Although studies show 80 per cent of men can return to sexual functioning after prostate surgery, many don't, indicating a possible psychological barrier.

Radiation therapy.

The administration of radiation to kill cancer cells for colon cancer or prostate cancer can cause damages to the blood vessels supplying to the penis.

This is another major cause of impotence. A study reported by the Journal of the American Medical Association showed that 25 per cent of all sex problems in men were caused or complicated by medications and other drugs. Tranquilizers, antidepressants, some high-blood-pressure drugs, corticosteroids (taken for arthritis), analgesics (for pain), alcohol, tobacco, and illegal drugs such as cocaine and marijuana affect libido and performance in men.

Others.

Surgery or other factors unrelated to disease can also cause erectile dysfunction. Take for example; long distance biking with small hard seats has been implicated as a cause of impotency, possibly by nerve compression. Habitual lifestyle like alcoholism, tobacco, eating habit and diet that causes malnutrition and lead to obesity.

Sam's case may seems psychological but as his doctor go in depth, it got more than it meets. Consider his age, at 50 plus, the onset and period of his problem, his medical background, the severity of the problem and other factors which may involve.